Conflicting opinions on cancer screening have caused a great deal of confusion for health care providers and the general public. This particularly applies to breast and prostate cancer screenings.
Most recently, the U.S. Preventive Services Task Force issued a definitive recommendation against using the PSA blood test to screen for prostate cancer in healthy men of any age.
Even in those who are at a high risk for developing prostate cancer, including blacks and men with a strong family history of the disease, the value of the test is questioned.
Their recommendation is primarily based on two facts: First, the task force maintains that the PSA does not reduce deaths from prostate cancer. Second, screening leads to needless biopsies (as many as one million annually) and unnecessary surgeries and radiation that frequently result in incontinence, erectile dysfunction and other urinary and bowel problems.
Many patients receive hormonal therapy to decrease testosterone levels. This often causes fatigue, weakness, osteoporosis and a poor quality of life.
Many urologists and cancer experts strongly oppose the notion of completely abandoning the use of the PSA. They maintain that early detection does indeed save lives, and worry that failure to detect prostate cancer early will lead to a far greater number of patients who develop widespread disease throughout their body.
Symptoms include severe bone pain and fractures, neurological issues due to spread of the tumor to the brain and many other problems.
Widely disseminated prostate cancer causes a great deal of suffering. Their point of view is strengthened by the fact that the task force recommendation was based on an American study that was seriously flawed with inaccurate conclusions.
Recently, an important research article was published in the New England Journal of Medicine that attempted to weigh the potential benefits of a PSA screening against the impaired quality of life as a consequence of further testing and treating prostate tumors.
In this study, the PSA test was measured every four years in 1,000 men between the ages of 55 and 69.
Their analysis predicted that the PSA test would result in an increased number of prostate cancers diagnosed, from 112 to 157 cases.
But the number of deaths from prostate cancer would decrease from 31 to 22 cases, and the number requiring end-of-life palliative care would decrease from 40 to 26. In this study, screening healthy men led to a 37 percent reduction in mortality from prostate cancer.